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Randy, try to keep in mind that Medicaid - although a joint Fed & state program - is run uniquely by ea state. So JoAnn’s experience in NJ is accurate & Alva’s in CA is as well, but an application for your mom in TX is gonna run a bit differently than 4 NJ or CA. Im guessing the NH - who has available Medicaid beds - has detected something in her financials that seems to be “gifting” & this is the basis of their telling u that mom won’t qualify.

My answer is based on this being your situation: Ages ago when 1st dealing w LTC (aka facility based) Medicaid for my handful of a MIL in Louisiana, it was easy peasy & caseworker super helpful. We got a short list of documents needed from NH admissions & MIL went in as “Medicaid Pending”. Abt week later caseworker gave hubs application & stack of financial documents back and said get her to under $2k then contact me. He wasn’t even going to start to input anything as MIL had too much $; so “spend it out then call me”. Then after she moved to TX, it was oh so much more complex. By the time I had to deal w my moms TX LTC Medicaid application, I kinda knew how financial & legal documentation heavy it would be. For both MIL & mom for TX, the NH gave us a list of documents (ea NH puts their list together, moms was 1 page, MIL was 2 as just lots more in minute detail) that needed to accompany State LTC application AND for both, it was the admissions person at ea NH who reviewed all documents first AND only if in their initial review they felt all was good to go did they submit entire packet along with their NH bill to caseworker assigned to the facility & accept them as “Medicaid Pending”. This was the system for TX for when we were dealing with the moms; other states may not do it like this. My mom was good on her financial stuff as far as NH concerned but MIL wasn’t as she had written checks out regularly to an aide to get her liquor & it looked like “gifting”. Took forever for BIL to get it resolved.

So imho if it’s NH staff who is telling you there's a financial problem then ime they detect something amiss w her finances & based on their experience, feel she will not qualify. I’d suggest that you Review whatever submitted & look at $ in detail. If she sold her home or a car w in past 5 years the entire amt from Act of Sale to her better have been deposited & to the penny. If theres anything that deviates big time from her regular pattern of income & spending, that tends to be a red flag for eligibility. Anything obvious???

So what is NH suggesting?.... they take her “pending” & she does the standard copay of her mo income but u sign off a financial responsibility contract? or private pay up front w contract? or they want her out?

There also is medical “at need” requirements for LTC Medicaid. She has to show need for skilled nursing care if she wants to be in a NH. Most go into a NH as rehab patient from a hospitalization so they come in w MediCARE paying for rehab & have a fat chart that clearly shows “need”. Then they cannot return home so segueway to LTC resident & file for LTC Medicaid to pay.
BUT
If your mom entered from being at home or IL or even in AL, that fat chart may not be there. So at a glance, she doesn’t appear to “need” skilled care. I had medical eligibility issues w my mom as she moved from IL into NH. I - as POA - filed medical appeal but nursing staff did follow thru on all health care documentation needed. It was that some RXs, labs & dx’s from her MD were left off. Medical eligibility is a whole different path to resolve & NH ime takes the lead.

anything else that could be an issue.... citizenship? her needs are more than this NH is set up for? any psych issues?
somewhere there r clues as to what the problem is.....
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Reply to igloo572
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I just read this differently. The NH is telling you that your LO won't qualify? Unless they have seen LOs financials how could they determine that? Did they start the application?

Medicaid has a cap for monthly income, my State its a little over 2300. If you LO is over the State cap, some States allow a Miller trust where the overage gets deposited to the Trust.

The house and a car are exempt assets if under the cap allowed. So you need to look at insurance policies that have cash value. Any type of savings. (employer policies don't count) Some savings are exempt. Those not exempt need to be used to pay for LOs care.

With me, Mom was under the monthly cap, she had enough money to pay 2 months care. I applied for Medicaid 90days before she needed it. Paying privately spent her down to 2k. I provided all paperwork needed. Verified with Moms caseworker all was done and Medicaid started paying the 3rd month.

If LOs assets and/or monthly income are the problem, then a lawyer, well versed in Medicaid, maybe a good thing. Medicaid allows the cost of a lawyer.
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If you are asking if all nursing homes must take Mecicaid residents, the answer is no. The nursing home only has so many beds reserved for Medicaid residents. The best ones have wait lists.
If a person qualifies for Medicaid then they will receive the next available bed anywhere, but not your choice.
NHs that currently have a paying resident that then qualifies for Medicaid will place that resident at the top of their wait list, thus leaving their wait lists longer
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Reply to MACinCT
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You should never allow a NH to apply for you. I personally set up an appt with a caseworker and he asked all the questions, I just provided the info needed. The only reason I had a lawyer was because of Moms house. And he cost her 5k. If she didn't have the house, it would have been pretty cut and dry. All she had was about 20k and her SScand small pension. I spent the 20k by placing her in a NH which gave me time to apply for Medicaid, get her spent down and get them info needed.

I would be very involved if using someone else to apply. In my State u only have 90days to spenddown, get Medicaid info needed and find a place for the applicant.
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Reply to JoAnn29
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No. Qualifications for medicaid is pretty cut and dry. If you are asking if there is asset-hiding stuff out there, yes, I imagine there is. Thought when you think of it, why should the taxpayer pay when the elder has assets? And many of them involve irrevocable trusts, with time sanctions, and etc. These Irrevocable Trusts are as good as giving your money away. It's out of your control.Why would anyone do that? So you sure could spend about 350.00 for an hour of time and explore options with an Elder Law Attorney. Up to you. Call one in your area and check costs for a consultation.
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Reply to AlvaDeer
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Someone to help me with my husband so he doesn't wonder off while I rest awhile.
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JoAnn29 Apr 1, 2021
You are asking a question on someone elses thread by replying. You need to set up your own question/thread to get answers.
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What kind of "homes" are you referring to?  Sorry, I'm not understanding who is allegedly stating that elder law attorneys can't help with Medicaid qualification.
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